Thursday, May 20, 2010

Kelly Higashi, chief of the Sex Offense and Domestic Violence Section of the U.S. Attorney’s Office, cites two cases of elder abuse: In 2008 Darryl Gaynor, 38, was sentenced to 24 years in prison for sexually assaulting his 72-year-old aunt in 2007. In 2008, Martin “Tony” Brown, 48, was sentenced to 24 years in prison for the 2006 murder of his 89-year-old grandfather.

According to a recent summary of elder abuse, anywere between 186,000 to 1.6 million older Americans are physically abused every year. Authorities fear that even higher rates can be found for elders dependent on caregivers.

Unfortunately, the rates at which these offenses are prosecuted is low. And even though elders visit doctors' offices frequently, it’s thought that physicians report less than two percent of abuse to Adult Protective Services.

A Hidden Crime

Elder abuse is a crime that is largely hidden. Research is limited, spotty, and incompletely reportede. It is believed that 90 percent of the time, the abusers are family members — and abuse cases wind up as classified as domestic violence, not elder abuse. The data also is misleading because the violence is difficult to describe.

A recent one-year study of women over age 50 took place in Rhode Island based on law enforcement response to reported domestic-violence incidents. Since older women are unlikely to have initiated a call to police, they are unlikely to cooperate. The study also found that elder-abuse events are underreported; meanwhile, police aren't likely to arrest older victims’ abusers as only a fraction of cases would be prosecuted. It’s thought that 25 percent to 30 percent of women abused by intimates, family or household members are re-abused after criminal justice intervention. Health care experts believe that how the state responds to the initial attack will have the greatest impact on repeat abuse.

Still, what do you do when, according to the National Crime Victim Survey (NCVS), up to 50 percent of victims do not report their abuse to police?

• Caucasians appear to be over-represented, while Hispanic and Asian victims are believed to be under-represented.

• Slightly more than half of the suspects were current or former intimates, including married, unmarried or dating partners of the victim. About forty-six percent were other family members. There is also the possibility of "suspect pairs," such as a daughter and son-in-law or two sons working together as abusers.

• Most of abuse by non-spousal relatives was intergenerational (94.5 percent), meaning that the family member abuser was at least a generation younger.

• The majority of abusers of family members were male, but 40.9 percent of abusers were female.

• More than a third of the victims reported they had been assaulted by the same suspect previously. Almost forty percent of those victims said they had been assaulted two to five times before.

The vast majority of victims try to cooperate with police as best they can, providing a written or oral statement or pointing out a suspect. Sometimes medical personnel spot abuse or a nursing home employee or mental health worker alerts police. Doormen, landlords, an employer and passers-by noted disturbances in the Rhode Island study.

Almost half of the suspects (48.9 percent) had a prior court history or cases involving multiple assaults. And 14.1 percent had previously been charged in an attack that was not domestic.

Other Elements to the Abuse

Sometimes victims are threatened, sexually assaulted, and deprived of property through theft or intentional damage. In the cases where money was taken, the amounts were generally small, ranging from $2.50 to $250. Three cars were also reported as stolen in the Rhode Island reports, as well as a set of car keys. Other stolen items included prescription drugs, including OxyContin, and televisions, food, and clothing.

Property damage caused by suspect break-ins include damage to windows, locks, doors and door frames. Other damage appears to reflect either a struggle or rampage in the house: damaged paneling, dishes, glass pictures, lamps, furniture, bedroom doors, coffee tables, and stoves. There was also reported damage to phones in a dozen incidents, probably reflecting the suspects’ effort to prevent victims from calling for police assistance.

Law Enforcement

When police arrive at the scene, they perform a number of tasks to investigate and take action if they have probable cause to believe a crime has been committed (including either arresting the suspect if present or filing an arrest warrant if the suspect is known and not present), securing evidence at the scene, and providing assistance and support to the victim. If the victim is 60 or older, in the case of the Rhode Island study, police must also report elder abuse to the state’s Department of Elder Affairs (See: R.I. Gen. Laws § 42-66-8).

Responding officers also look for witnesses. They photograph any visible injuries; confiscate weapons or firearms; and give victims rights-and-safety pamphlets. By the time police arrive, about 20 percent of the suspects have left the scene, so police file arrest warrants for them, typically charging misdemeanor assaults, simple domestic assaults, or simple assaults.

Bruising is a Major Sign

Conventional wisdom is that bruising is normal in elderly people due to accidental falls. Most people think that because older people have thinner skin and less subcutaneous fat they bruise more often than their younger peers. For that reason, researchers decided to study “normal” bruising in elderly people and then follow up with a separate study of bruising caused by physical abuse.

To learn what normal bruising looked like, researchers recruited 101 people 65 and older, with an average age of 83. Trained interviewers went to their homes every day for six weeks. They examined participants from head to toe for bruises. Each bruise was photographed, and its location, size and color documented. Interviewers also noted how long it took for the bruises to fade.

They found that 90 percent of the bruises were on the extremities. Not a single accidental bruise was found on the neck, ears, genitals, buttocks or soles of the feet. Of the 20 large bruises (larger than five centimeters—about two inches—in diameter) only one occurred on the trunk of the body.

They found that red and purple were the most common colors on the first day a bruise appeared. However, some fresh bruises were yellow, a significant finding because many people believe that yellow bruises are more likely to be fading older bruises. Indeed, yellow was the most common color in bruises that stayed visible for more than three weeks.

Bruising from Abuse

Once researchers knew what accidental bruising looked like, they turned their attention to deliberately inflicted bruising. Stark differences emerged. The team of researchers examined 67 people, 65 and older, who had been reported to adult protective services as possible abuse victims. Seventy-two percent of those who were physically abused no more than 30 days before examination had bruises. When compared with the previous group (who had not been abused), they had significantly larger bruises. Abusive bruises are often larger and more than half are two inches or more in diameter.

The physically abused elders were much more likely to have bruises on the head and neck, especially the face, and on the back. Researchers also noted significant bruising on the right arm, perhaps because people raised their arms in an attempt to block an attacker.

Another important finding is that 91 percent knew what caused their bruises. Only 28.6 percent of the comparison group—those who had normal, nonabusive bruising—remembered the incident.

Aileen Wigglesworth, a gerontologist and assistant professor at the University of California, Irvine, worked on both studies. Wigglesworth said that although the studies give police and prosecutors forensic markers that are vital tools in elder abuse cases, more work remains on other fronts, including such basic issues as the credibility of people who ask for help.